Medical cannabis is a new area of medical practice, but one with ancient roots.
Increasing evidence for the use of two extracts from the cannabis plant in some medical conditions has lead to regulation changes allowing doctors to apply to prescribe medical cannabis products on a named-patient basis.
The result is an exploding market for cannabis products in Australia, but there are misconceptions regarding freedom of access, medical uses and the costs involved for the patient. Also, cultural issues continue to obscure the simple reality that medical cannabis represents a 'new' family of potentially useful drugs for our use as practitioners in some conditions - it is not mystical panacea!
Below you will find some useful information regarding medical cannabis: It’s prescribing, it’s use-cases, and some of the practical, legal and financial limitations that patients should be aware of. If having read this information you think medical cannabis might help you, please contact us on the number provided to find out about Swansea Channel Doctor’s Medical Cannabis Service.
‘Botanical Cannabis’ includes three species of plant that are cultivated by humans for their therapeutic effects.
As a ‘traditional’ medicine it only came to be prohibited in the industrial era due to it’s unregulated recreational uses, competing political interests and health concerns. While this ‘Establishment’ perspective clearly carries an agenda, the recreational cannabis user who holds that cannabis is some magical panacea is equally flawed.
In 2020 these sorts of partisan views are being challenged by the scientific evidence, as we look to the medicine beyond the ‘myths’, and it’s potential uses.
Medical cannabis isolates the 2 main active ingredients from botanical cannabis, CBD and THC:
CBD does not have psychoactive (’psychedelic’) effects, and is found in hemp. Examples of CBD’s use is for functional disorders, childhood epilepsy, and depression/anxiety.
THC is the psychotropic compound sought by recreational cannabis users. Used medically, examples of THC’s uses are chronic pain, insomnia & nausea.
Interestingly, it appears using both CBD and THC together is more effective than used separately. This ‘good’ polypharmacy is known as the ‘Entourage Effect’ and is not well understood yet.
The State permits the potential use of medical cannabis, but ONLY where traditional treatments have been tried and failed, AND ONLY for specific conditions, including:
PHYSICAL HEALTH — chronic pain, nausea, migraines & neurological conditions
MENTAL HEALTH — anxiety & depression, insomnia & PTSD
CANCER CARE — pain, nausea & anxiety
An individual application covering all these details must be made by the doctor to government, on a NAMED PATIENT basis (ie there is no anonymity). The decision on issuing the use Authority belongs to the State.
Cannabis leaves and flowers produce hundreds of cannabinoids — biologically active, natural compounds that interact with the body's ‘endocannabinoid system’, via our CB1 and 2 cell-receptors.
This system has only recently been mapped, and found to be deeply involved in the body’s self-regulation, cell-signalling, and feedback pathways. Also, more directly involved with our ‘holistic sense of wellbeing’ than the more conventionally understood (and abused) opioid and serotonin systems.
(For any ‘Alt Medicine’ — yes, this is a good example of the limits of medicine: that we need to be able to ‘prove a thing’, before we can confidently use it!)
The traditional method of dosing cannabis by smoke inhalation is a particularly lethal example of ‘bad’ polypharmacy.
The chemistry of burning these plants yields even more chemical compounds, many known to be harmful. It should be noted that gram-for-gram cannabis smoke is more dangerous than tobacco!
While the alternative of ‘vaping’ is hoped to be safer for users, it also yields uncontrolled chemistries, & the process of vaping may still have unknown consequences.
As doctors, ‘First do no Harm’ means medical cannabis needs refining, usually into an oil, ingested.
Depending on the use case and the nature of the patient, product selection and starting regimes are standardised, and then individually tailored to suit.
Adjustments are generally made every 5–7 days, so follow-up and patient commitment is intensive until we have clear benefit and stability.
Toxicity is very low compared to opiates & benzodiazepines for example. Indeed, there is the prospect of simplifying a medication regime, for the introduction of a dose of cannabis.
As an area of special responsibility for the doctor, it is not ‘bulk-billing medicine’! The patient will also have a product supplier & pharmacist to consider.
This is not to say we should all be smoking cannabis! For example, no-one can completely predict the effects of so many compounds at work, when doctors already refer to the interactions of just 5 or more medicines as ‘polypharmacy’:
Polypharmacy — Too much going on, to ever be sure of your results…
So using the close analogy of tobacco, as doctors we cannot assume that the complexity of ‘whole-plant products’ is necessarily always ‘beneficial’. Rather, the ‘unknowable’ potential benefits vs toxicities of whole-plant medicines, is the argument for medical cannabis — clarity about what is going on.
Although there is now a regulatory framework for medical prescribing, today cannabis remains illegal in recreational use, i.e. when ‘self-prescribed’.
If considering the option of medical cannabis, patients must understand that it remains illegal to drive while using cannabis from any source, including your doctor, and is a danger in any circumstances involving ‘risk’.
A medical prescription for cannabis does NOT provide protection against prosecution in the event of a drug test, and the medical advice will always be ‘you should not drive’. The analogy here is with alcohol use, only there is no acceptable ‘lower limit’ for THC levels when tested.
1) There is NO guarantee of an Application’s success. We only ‘argue’ for its appropriateness.
2) There is NO ‘general wellbeing’ treatment option that might equate to recreational uses — doctors cannot legitimise lifestyle use.
3) There is NO evidence that cannabis alters outcomes, or cures serious diseases such as cancer or neurodegenerative disorders. It is for symptom-management only in such cases.
4) PBS (Medicare) does NOT FUND the cost of cannabis products, just agrees a use-case. Presently, the patient bears all ongoing costs of medical cannabis treatment.
Ready to jump in? Read On!
STEP 1: Make sure you are familiar will all of the information above. To then book your comprehensive, 60 min consultation with Dr Smith, ring:
02 4971 6663
Total $400 (rebate of $118) $250 payable at time of booking and non refundable, and $150 payable on the Day (See T&Cs below). Once booked, Download the ‘Information, Consent & Agreement Form’ to complete and bring to your Appointment
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STEP 2: Your initial ‘One-Stop’ appointment, to assess whether cannabis is right for you. This will include a review of your global health, medications & your goals, with an application to the TGA for Approval made
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STEP 3: Response from the TGA (2-5 days) and if Approved your Prescription & Approval readied for your collection from us. You take this to the Pharmacy, who will order in the product for you to collect (2-4 Days)
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STEP 4: Weekly follow-up, in our standard 15 min appointments ($95), until you have achieved a stable dose & are confident with your cannabis. Review of the benefits & any issues. Also updating your approval(s) & scripts. The goal is simplifying and ‘normalising’ your medical cannabis use alongside your other medications ( 1-3 months)
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TERMS & CONDITIONS:
ON PRICING: Australia has a framework for prescribing medical cannabis, but it is not funded in any way. Cannabis services are therefore necessarily privately charged - funded by you, the patient.
OTHER LIABILITIES: The TGA decides whether an Application is approved; this cannot be ‘guaranteed’. However, a sensible application on behalf of appropriate patient who knows the rules is usually successful.
DRUG TESTS: While ‘common sense’ generally applies in the case of a failed random roadside drug test in a patient who can demonstrate they are being treated with medical cannabis, the law entitles the police to take matters further if they choose, eg if they suspect ‘dangerous driving’. No driver has a ‘Pass’ in the eyes of the law, even under medical treatment. Other interested parties may act similarly, for example Employers.